Thu August 16, 2012

Fact-Checking The Future Of Aging In America

This is TALK OF THE NATION. I'm John Donvan in Washington; Neal Conan is away. The boomers, the Americans born between 1946 and 1964, from the start they have cut a wide swath through the American landscape, which just had to keep on accommodating them.

Once, when they were small children, the nation had to build extra schools in a hurry to give them an education. That was an obvious move. But now that the boomers are brinking over into their own senior years, what's ahead? What has to be built now, literally and figuratively, to accommodate the largest senior population the U.S. has ever seen: 76 million boomers who right now are turning 65 at the rate of 10,000 per day, which will ensure that nearly 20 percent of the population will be at least age 65 by the year 2030.

If you ask the boomers about this themselves, they seem to be a pretty optimistic group. Polled by the National Council on Aging, UnitedHealthcare and USA Today, many said they expect that they're going to be in good health and in good circumstances as they age.

So how exactly do they see that happening? That's the question mark. Does boomer optimism need a reality check? Does this emerging generation of seniors need to be making a better plan? Boomers, what is your plan, if you have one? And if you don't, why not? Our number is 800-989-8255, our email address is talk@npr.org.

Later on the program, Sister Mary Hughes on the nuns' ongoing battle with the Vatican. But first Dr. Rhonda Randall joins us by smartphone from her office in Orlando, Florida. She is a geriatrician and chief medical officer of UnitedHealthcare Medicare and Retirement. Nice to have you with us, Dr. Randall.

RHONDA RANDALL: Thank you, John, it's a pleasure to be with you and your listeners this afternoon.

DONVAN: Let me clarify one thing: Are you a boomer yourself?

RANDALL: I am not. I'm an echo-boomer.

DONVAN: OK, well, I am a boomer.

RANDALL: The smaller boom that followed the big boom.

(LAUGHTER)

DONVAN: Well, I think then it would be a good thing for us to find a common language across the generational divide because I think what we're talking about, in a sense, is having some outside perspective for boomers on what's coming down the road for them and whether, as somebody earlier in the program we heard mentioned the word delusional about their expectations that life is going to be just peachy and rosy as they age.

So you were involved in this poll in which they sounded pretty optimistic. What did they say? What were they optimistic about?

RANDALL: Well, we worked together with the National Council on Aging and USA Today to survey 2,250 older Americans across the United States earlier this summer. And the most striking thing that they told us, that I was actually very happy to see, is how optimistic they are about aging and about their future.

We know that attitude has so much to do with health and well-being. So I think that's very good news in this story. We looked at how ready they are for aging, whether or not they have any chronic conditions today, how they plan for caregiving, how they plan for the financial aspects of health care, their other long-term-care needs.

And when you get into some of the meat of that data and more of the details, what you do see is some things that I would say cause concern or pause. The first for me was that many of these seniors, over 52 percent of them say they exercise or are physically active at least four days a week, great news.

But we had a significant number, about one in 10, say that they rarely do physical activity, and 11 percent say they're never physically active at all. And so when you look at lifestyle choices and what we see in other data points and other surveys that we've done, like America's Health Rankings, that we have issues like obesity and diabetes on the rise across the nation in all age groups.

And the reality is is that as we age, we're likely to develop chronic conditions as a result of those lifestyle choices. For those 20 percent or so that are couch potatoes, it's not too late to make a change in your lifestyle that can really affect the health that you'll have as you age.

DONVAN: So you're saying that boomers are optimistic, and that's good because it's better to be optimistic. I think you're saying it's better for your health if your outlook is positive than if it's negative.

RANDALL: I would agree with that.

DONVAN: At the same time, you're saying that maybe the optimism is somewhat misplaced?

RANDALL: For some. So I think that for some, the optimism may not coincide with what reality could be. So we know over the age of 50, about 20 percent of us will have one or more chronic conditions. But we age over the age of 65, that number changes significantly so that 62 percent of us have two or more chronic conditions.

These are things like diabetes, heart disease, high blood pressure, arthritis and so forth. I think a lot of folks don't recognize things like that as a chronic condition, right, may not recognize high blood pressure is a chronic condition, that you're going to need to do something to control it, whether it's lifestyle changes or medication or a combination of the two.

DONVAN: Is this a different thing, do you think, to be aging now - and by aging I don't mean just going through life but I mean reaching those later years - is it a different thing to be aging in that sense now than it was 30 years ago?

RANDALL: Yes and no. I think what we see 30 years ago is, first of all, the generation and the two generations that have come before the boomers that are often called the greatest generation or the silent generation, they have really blazed trails in aging. We see a fast-growing centenarian segment of our population, so those people who have celebrated their 100th birthday or more than 100 candles on the cake are one of the fastest-growing segments of our population.

So the boomer generation can learn a lot from looking to the generations ahead of them. I think with the boomer generation, they have had more opportunity for advanced education, they've had more access to technology and all of the growth in that over their lifetime, and we see this is a group with large amount of consumerism, as you mentioned earlier.

They have changed every aspect of their lives that they have gone through just by their sheer volume. So as you opened the program and mentioned how schools had to change, once this group of individuals entered the workforce and started to have buying power, think about the companies that have marketed to that volume of seniors.

So I think that we'll see the same with health care.

DONVAN: There could be an enormous demand for artificial knees and artificial hips.

(LAUGHTER)

DONVAN: But actually, literally that's true, that that sort of technology, as you were referring to before, really does put an older person back on his feet now in a way that 35 years ago would not have happened. It would have been a life of convalescence, of being in bed basically, if you couldn't walk around, and now you have a chance of getting back on your feet.

RANDALL: Absolutely, and, you know, we are living longer than we ever did, and we would expect that the boomers are likely to live longer than their parents. And, you know, I want to bring back to that reality that the longer you live, the more likely you are to have or develop a chronic condition.

So start planning and think about what you can do now to prevent or minimize that.

DONVAN: You just said the magic word, planning, because that's what we're asking our listeners to call us about. We want to know what their plans are, and if they don't have one, we want to know, you know, is that on purpose, or is it an oversight. Our number is 800-989-8255. We're talking with Dr. Rhonda Randall.

And let's go - let's begin this conversation. Let's bring in William(ph), who is in Hickory, North Carolina. Hi, William, you're on TALK OF THE NATION.

WILLIAM: Hi.

DONVAN: Hi.

WILLIAM: Good afternoon, thanks for taking my call.

DONVAN: Sure.

WILLIAM: Now, I turned 62 my birthday this year, in March, and I planned this time next year to retire. I have developed a kind of a hobby that's going to provide me with some income. But, you know, with all the extra parts that we can get now, you know, knees and hips and that, I plan on being around and seeing my 100th birthday. I'm so - I'm really optimistic about that.

And we've had a good life growing up. We're very optimistic about everything, and...

DONVAN: And so a future living to 100 does not scare you?

WILLIAM: No, no, no, absolutely not. I want to be able...

RANDALL: Well, good for you.

WILLIAM: I want to be able to - I have four sons, and I'd like to see every one of them be very successful in life. I plan on being around. They know they're going to have to take - they're going to have to take care of Daddy.

(LAUGHTER)

DONVAN: All right, let's let Dr. Randall - let's hear her thoughts on what you've just shared with us.

RANDALL: Well, it sounds like you have done some planning, and the last thing that you mentioned was that you hope that your sons are going to need to be there to care for you. So you've thought about caregiving, which is an important part of planning. You know, hopefully you'll maintain your independence well until your 100th birthday, but should you need assistance to help with your activities of daily living, you know, it sounds like you're already thinking about where that help would come from.

DONVAN: William, thanks very much for your call. I want to read an email that we've received from Susan(ph), who looks at this a very different way. She writes: Having witnessed my mother's experiences in various living and health experiences, I'm very disheartened about future health care and living opportunities for people who are unable to live independently. I'd hoped that I would see improvement as time went on, but I'm not. As a result, I don't want to live to the point where I have to be cared for by others.

What about that, Doctor, and have you heard that attitude before, that there are people - I literally was asking William does he really want to be around until 100, and he loved the idea. It sounds as though Susan is saying that she doesn't see that as a great outcome at all.

RANDALL: Well, I think one of the things that Susan's email for me brings up is the idea of aging in place. I think when we survey seniors and ask people if you have the opportunity to age in your home instead of moving to a congregate living facility, would that be your choice? And generally we see about 90 percent of seniors saying yes, if I have the option to live out my years in my own home that would be my preference.

We're very fortunate that I think we've got good long-term care options in this country. And I have seen, from where I sit, an increase in home- and in community-based services around the country that can support that. But I would agree with what your writer is saying, that it's not happening fast enough.

So hopefully we will see again, with this massive wave of folks aging into this group, that there will be a greater demand and that the market will respond.

DONVAN: OK, well, we are talking about aging in America. Are boomers ready for it? Do we need a reality check? Boomers, what is your plan, if you have one, and if you don't, tell us why not. Our number is 800-989-8255. Or email address is talk@npr.org. I'm John Donvan. More on this when we come back. This is TALK OF THE NATION from NPR News.

(SOUNDBITE OF MUSIC)

DONVAN: This is TALK OF THE NATION. I'm John Donvan. Baby boomers can expect to live almost now to the age of 70 on average. That's according to the life expectancy estimates for people born around 1950 or 1960. We're talking today about whether we are really ready for those years as we grow older.

A recent survey shows that boomers are optimistic in general about their health and their future, but they did express some anxiety about how to pay for things like long-term care. So boomers, what's your plan if you have one? And if you don't, tell us why not. Our number is 800-989-8255. Our email address is talk@npr.org. And let's bring in Jay(ph) in the conversation. Jay is in Nashville, Tennessee. Hi, you're on TALK OF THE NATION.

JAY: Hi, thanks for taking my call.

DONVAN: Sure.

JAY: My concern is health care, and my concern is if we have a change in the Medicare and Medicaid as we know it now to something like Paul Ryan's plan, this is the scenario that I'm worried about. I'm given a voucher to get health insurance in the private sector, and as a senior, I'm most likely going to have a pre-existing condition, which means either, one, I'm going to get a rider on my health insurance which says I'm not going to pay for your high blood pressure or your diabetes or your high cholesterol medicines; or I have a pre-existing condition so I'm not going to be eligible for health insurance.

And that is one of the things that I'm very concerned about.

DONVAN: All right, Jay, I'd like to have you take - I'd like to take that question to our guest, and we're now going to expand our roster of guests. We've already been listening to and talking with Dr. Rhonda Randall, but I want to bring in Fernando Torres-Gil, who served as first assistant secretary for aging under Bill Clinton and now is associate dean of academic affairs and professor of social welfare and public policy at the UCLA School of Public Affairs. Fernando, thanks very much for joining us on TALK OF THE NATION.

FERNANDO TORRES-GIL: Thank you, it's a pleasure to be with you.

DONVAN: So you heard Jay's comment, and it really - it goes to money, and it goes to politics. And are those things that boomers need to be thinking about and acting on?

TORRES-GIL: Well, let me first say at the outset I appreciate Dr. Randall's insights, which are right on point. And I myself, I'm a baby boomer, born in 1948, so therefore at the leading edge of this very large cohort. The question by this speaker points out what I believe is going to be a crucial period in 2012 and 2013, no less than determining the direction that the federal government will take in responding to the aging of baby boomers and perhaps maybe a wakeup call for all of us who expect to be part of that generation and live a good long life as to what we expect from government and what we expect for ourselves.

The question posed by this individual is a critical one, and we're going to hear a lot of political debates and even confusion over whether or not Medicare will be saved by this candidate or destroyed by another candidate. But if I can just inject what I believe is the more accurate perception, the president's Affordable Care Act, for example, will slow down the growth of Medicare to about $750 billion worth of saving, but preserve Medicare as we know it.

The challenger in this race and his new vice presidential candidate has made it clear in his documents that he would essentially replace traditional Medicare with a voucher plan where individuals take whatever amount the government provides and hope they can find a private health insurance policy that can meet their needs.

That, I think, is going to be the great debate - do it ourselves and rely on the private sector or continue to rely on government.

DONVAN: So Fernando, does that leave boomers in a position where - you know, we're asking people, what's your plan, what plan are you going to make? You know, given that we're hanging on that decision to be made by the electorate, does it mean that we're not in a position to know what plan to make because we don't know what the...

TORRES-GIL: Well, let me step back and respond to the survey. I think that will help to get at your question. First, I too, like Dr. Randall, I'm happy that my generation is happy and optimistic. However, at the risk of sounding too somber, when we look at the actual data and trends, baby boomers are facing what I would call unreasonable and unsustainable expectations.

DONVAN: Such as?

TORRES-GIL: The majority do not have adequate retirement savings. The reality is that Medicare and the Medicaid programs are under assault and may not be sustainable in the current version. And baby boomers can expect to live a longer life and are wholly unprepared for the high cost of caregiving and long-term care.

So I believe our generation is going to be facing some rude shocks.

DONVAN: Well, we heard from a listener, William, before, who was talking - he was just darned enthusiastic about the future and his ability to live to 100. Do you think that he's a little bit out of touch with - you know, we don't know his particular circumstances, but does that concern you? Do you think that he hasn't thought through the day-by-day and the dollar-by-dollar?

TORRES-GIL: Well, let me raise a hypothetical situation with that very optimistic individual with four sons. Assuming this individual has his own defined benefit plan with a guaranteed pension and a cost of living increase that will survive for the next 30, 40, 50 years, assuming this individual has four sons who are willing to provide hands-on intimate care and/or have their father move in with them, assuming this individual even gets along with his sons over time, and assuming this individual has the moneys to pay for the increasing out-of-pocket cost, then he may be in pretty good shape.

The majority of Americans that are part of the baby boom generation do not have those guarantees. Already today, for example, one in three baby boomers is single, primarily divorced, never married, or widowed. So I would suggest this individual is an outlier, an ideal optimistic outlier.

But all the trends indicate the opposite end of that spectrum.

DONVAN: Let's bring in Sheila(ph) from Pittsburgh. Hi, Sheila, you're on TALK OF THE NATION.

SHEILA: Hi. I have a similar perspective to the doctor who was just speaking. I am 56 years old, so I am a baby boomer, but I have also practiced as a hospice nurse for some time. And more and more I see people who are attempting to get hospice care not because of a single terminal condition but because of general debility. They have a myriad of serious problems caused by things like diabetes and cardiovascular disease that leaves them with dementia, inability to ambulate and take care of themselves.

And Medicare pays for, you know, treatments for these different things, but there really is no good plan to take care...

DONVAN: Do you - can I interrupt you to ask you, do you have a plan yourself, Sheila?

SHEILA: Well, actually, being a hospice nurse, my perspective is very different from the general public, and I see nothing wrong with dying, and when the time comes, I'm going to allow myself to succumb to the first serious illness that I have.

(LAUGHTER)

SHEILA: I've lived a good life.

DONVAN: You're not praying for that moment to come, it sounds like.

SHEILA: Oh no, no, no, no, I will - and as a matter of fact, I take good care of myself. I eat a good diet. I exercise regularly. So I intend to live as well as I can, until the time comes. I have a - I don't care to live as long as possible because I see how life deteriorates with each event that an elderly person suffers, and...

DONVAN: Sheila, thanks - yeah, I want to thank you very much for your comment, and particularly I want to take the last point that you made back to Dr. - to Dr. Randall. You know, Sheila's saying because of her work as a hospice nurse, she has seen what old age looks like, and she's really indicating that it's not necessarily particularly pretty and sweet. And I want to ask you, Dr. Randall, as a geriatrician: Do those of us who haven't reached the later years not really know how difficult it can be from a medical point of view or even an emotional point of view?

RANDALL: Well, I want to thank Sheila for her call and her comments. I too have a background in hospice and palliative care, and I want to thank you for the work that you do. You bring such comfort to people who are otherwise having a poor quality of life. So thank you for the work you do, Sheila.

I think she brought up two very important things. The first is this idea around multi-morbidity leading to disability. And we know that someone's functional status, their ability to take care of themselves and do their activities of daily living, like getting dressed, getting to the toilet, doing their grooming, feeding themselves, those types of activities, the lack of being able to do that for yourself is probably the single biggest predictor of morbidity in the country.

But the other thing that we're seeing is, as we age, like I said earlier, greater than 62 percent of people over the age 65 are going to have two or more chronic conditions; that increases as you age.

DONVAN: But Dr. Randall, let me...

RANDALL: We don't have...

DONVAN: Let me come to my...

RANDALL: Yes?

DONVAN: ...to bring you a little bit more into focus to the question I was asking, which is, are we a little bit naive about those realities, those of us who haven't seen it up close?

RANDALL: I think that those of us who haven't seen it up close have a tendency maybe to take things for granted that those of us who've seen it up close do.

DONVAN: Mm-hmm.

RANDALL: And I think it also highlights really the need for all adults to do advanced care planning, which is one of the things that we didn't ask about in the survey, but it's one of those other aims of planning that I think is so important. I expect this baby boomer generation to be fiercely independent about preserving their autonomy and making their own decisions, even when they are past a point where they're able to speak for themselves. So having conversations not only about care-giving and finances and long-term care but also about who will make my - who will be my spokesperson if I'm ever too sick to speak for myself, those are such important conversations.

DONVAN: And it looks as though we've turned the corner a little bit in the conversation to talking about what can be done or what can be tried. And we have an email from Ellen in Baltimore, who asks, could you ask your guests to discuss the growing movement for community housing? Fernando, can you take that on?

TORRES-GIL: Oh, certainly, happy to do so. First of all, when we ask baby boomers what are their preferences in terms of where and how to live, the vast majority will first say not in a nursing home, thank you. And then the second response is: I want to age in place in my home, and if I need help, I want that help in my home. And that goes back to the, what I referred to as the unreasonable, unsustainable expectations, because the reality right now is, first of all, very few individuals have any coverage for the high cost of home and community-based care.

The only way you can get it through public financing is Medicaid, but you have to spend down to poverty levels; Medicare very limited home health care. We have a class public insurance program that was part of the Affordable Care Act for long-term care, but that's not going to happen because of disputes on the Hill. And for some of us, including myself, I have private long-term care insurance, but most insurance companies are getting out of the business.

So the first reality about how we grow old is where will we be taken care of, and very few people have planned ahead. To stay in one home assumes that we have prepared for a variety of contingencies. A) Most of us will lose our driver's license, so how will we get around? B) Can we afford to maintain our home over a 10, 20, 30-year life cycle? And C) it's actually more expensive to provide long-term care at home than it is in an institutional setting, like a nursing home, assisted-living facility, or long-term care residential community.

And I think therein lies the pending first crisis facing baby boomers, that most of us are not prepared to age in place and need assistance, especially with care-giving and long-term care.

DONVAN: Let me read an email that's just come in from us by somebody who identifies him or herself as MenHoliday(ph), and this is a little bit long, but it's interesting because it goes directly to what you just said, somebody who's come up with a creative solution. I'm a boomer, and three years ago, about 50 of our neighborhood seniors got together and we formed an aging-in-place project. We not only want to live independently in our own homes, but we want to remain in our community as integrated and contributing members to the overall diverse society.

At this third anniversary of our project, we are focused mostly on social networking and building social capital with one another so that we have a support system in place as our aging continues. We focus on health - physical, cognitive, psychosocial. Our activities are fun and they're enriching, but they're all focused on our current and future health needs. Our secondary focus is education. We learn about aging issues, maintaining our health and well-being.

Our group does have a care team in place. We offer some care-giving and helping services to members in need. As we all age, we'll have additional needs, and some of those needs cannot be met by volunteers. But it is our intention to keep growing and trying to keep pace with changing needs by supporting each other as a group across reliable, trusted services, much like a family or a village would support its members.

TORRES-GIL: This is a wonderful concept, and it's referred to, incidentally, as a village movement in aging. In fact, it's a good model for looking ahead, and given the large number of baby boomers that are expected to be alone, independent, even isolated, I think it points out the need for all of us - I'm at 64 years of age - to begin to build the supportive and reciprocal relationships, whether it's communal, relying on friends and families and neighbors and/or starting to plan ahead for housing which will allow us to rely on others when we are in need. So it's an excellent model, but it's a limited model.

DONVAN: But where do you go - you know, we only have two minutes left, and the message doesn't sound great. You're describing a generation that is not prepared.

TORRES-GIL: Well...

DONVAN: And, you know, if somebody wants to do something like this project or in some way improve their prospects, where do you go? What are the resources?

TORRES-GIL: Well, this is the new frontier. In fact, there's no central master plan that we can rely upon for these great ideas. In many ways we, as baby boomers, have to educate ourselves with - in gerontology and geriatrics. We need to become more expert in terms of aging. Keep in mind that this is a new frontier. Never in human history have we had this wonderful opportunity to live this long life. We're going to be making it up as we go along.

DONVAN: And I hope at your 100th birthday, when you blow up a hundred candles, you can do it in one breath, and that I'll be there with you.

TORRES-GIL: Thank you.

DONVAN: All right. I want to thank Fernando Torres-Gil, who served as the first assistant secretary for aging under President Bill Clinton. He joined us from member station KPCC in Pasadena. Thanks very much for joining us. And Dr. Rhonda Randall is a geriatrician and chief medical officer at UnitedHealthcare Medicare and Retirement who joined us by smartphone from her office in Orlando. Thanks very much for joining us, Dr. Randall. Transcript provided by NPR, Copyright NPR.